New year, new look for Target Tendonitis

Well, it’s 2018 and the Target Tendonitis website, as you can see, has been redone with a completely new look. The old site was getting kind of stale, and some of the back-end tech stuff was out of date, so I hired a guy to come in and overhaul the whole thing. The site is still being built out; I’m in the process of porting over all the old blog posts and stuff, but the main part is here and done. Hope you like it!

In the same spirit, I am going to release the fourth edition of Target Tendonitis soon. It will have links to even more videos, an expanded FAQ section, and some updated nutritional recommendations. If you order the 3rd edition now, don’t worry; if you want the updates I’ll be happy to send you the new version once I get it done. Just shoot me an email (the address is in the ebook) and I’ll put you down on the list.

Finally, I’ve decided to start posting about topics other than tendon pain. I’ll still keep on with the tendon information, but there’s only so much that can be said about tendons, and I want to expand the blog to encompass some other topics relating to general health and fitness (especially for us older folks, those on the far side of fifty). So I’ll be talking about exercise, and nutrition, and body maintenance not only as they relate to tendons specifically, but on more of a general level as well.

Best wishes to everyone for the coming year (and beyond!), and I hope that this blog will become even more useful as time goes on.

Alex Nordach, author of Target Tendonitis









Tendon Degeneration

I got a very interesting question the other day from someone who saw one of my videos on YouTube. He asked: “How can there be a quick recovery for tendonosis, which is tendon degeneration, if it takes collagen (what tendons are made of) 100 days on average to regenerate?”

This is a really excellent question, maybe the best one I’ve ever gotten. To begin with, it’s important to remember that “degeneration” doesn’t always mean “destruction”. Degeneration in the context of tendonosis can mean several things, one of which is destruction of the collagen fibers (such as is sometimes seen in the case of Levaquin patients, and in those cases recovery generally does take several months, if it happens at all), but most of the time it simply implies a degeneration in function or ease of movement rather than actual damage to the collagen fibers themselves.

What happens is this: in much the same way that adhesions affect muscle tissue, tendons that are affected by tendonosis develop points or sections along the fibers that begin to stick together. With muscle fibers, the mechanism is pretty clearly understood: tiny fibers are grouped into bundles to create larger fibers, which are in turn grouped into still larger bundles, until you have a three-tier structure.

These bundles slide along each other at every level when a muscle is functioning normally, but when adhesions develop they stick at certain points, which then causes pain during movement. A good physical therapist can usually find these points simply by feeling along the muscle, and then use finger pressure to break up the adhesions and get the muscle back into good working order.

With tendons, the situation isn’t as clear. For one thing, tendons don’t contract…but they do stretch. Perhaps because of this, generally speaking simple finger pressure or massage is not enough to break up the adhesions that form. This is partly because collagen isn’t as flexible as muscle fiber, and partly because the location of the tendon itself can be harder to get at. Also, since tendon fibers don’t slide along each other the way muscle fibers do, the theory is that the collagen fibers somehow get intertwined, developing what might be visualized as “crosshatches” of collagen. What’s needed is a way to re-align the fibers so that they no longer interfere with each other.

If you could somehow run a comb through the collagen and “comb it out straight”, that would be ideal. But since that’s not possible, the next best thing is specialized exercises that, over the course of a couple of weeks, will usually accomplish the same effect. This does not need to cost a lot of money; there is a large body of research that shows that simple tendon strengthening and rehab exercises done at home can be just as effective as platelet-rich plasma and other such “cutting-edge” treatments.

Bye-bye, Food Pyramid

In a long overdue move, the United States Department of Agriculture (USDA) has gotten rid of the famous Food Pyramid that for close to two decades was supposed to tell you how to eat. The new symbol is a plate-and-cup that will hopefully be easier to understand.

Michelle Obama, Agriculture Secretary Tom Vilsack and Surgeon General Regina Benjamin got together to announce the new paradigm, but the message seemed to be a little contradictory. According to Ms. Obama, parents “don’t have time” to measure out portions of food…yet, according to Dr. Robert Post, Deputy Director of the USDA Center for Nutrition Policy, “We know that with proper planning, you can get enough protein” from a vegan diet.

Hmmm. I can tell you from personal experience that, once you have the scale, it takes about ten seconds to measure out a portion of anything. On the other hand, I know very few vegans who actually (a) combine plant proteins properly on a regular basis and (b) get enough overall protein into their bodies (which is probably why so many of them start looking gaunt and eventually go back to eating animal sources). I have nothing against any particular diet plan, so long as it’s healthy, but let’s be clear about the realities of eating. Weighing food takes almost no time at all, and there is no better way of coming to grips with the reality of what you’re putting into your mouth–it’s just that it’s a bit of a hassle.

Anyway, time will tell if this new plate-and-cup idea takes hold. Meanwhile, if you have long-term tendon problems, here are some food-based issues to consider:

If you are overweight, the first thing to look at is losing the excess poundage.
If you are underweight, are you getting enough good fats in your diet?
For any American male, do you eat a preponderance of red meat versus fish and nuts?

Any or all of these can be (and probably are) contributing factors to your tendon pain. Fixing them is one step toward having healthy tendons and preventing recurrences of tendonitis/tendonosis. For more information about nutrition and supplementation as they relate to having healthy tendons, check out my book Target Tendonitis.

Capsaicin for Tendonitis

I’ve been seeing a lot of talk around the internet lately about using capsaicin to relieve or cure tendon pain. The idea is that, applied topically, capsaicin will activate the pain nerves, but then make them less sensitive (through an overload effect), so as to reduce the overall amount of pain.

For example, this site says :

Capsaicin “numbs” the sensation of pain in joints affected by tendonitis. This effect occurs from capsaicin blocking the production of a neuropeptide named substance P, which is responsible for the sensation of pain.

and then lists this study as their reference: Deal, C. L. The use of topical capsaicin in managing arthritis pain: A clinician’s perspective. Seminars in Arthritis and Rheumatism. 23(6):1994;48-52, 1994. I won’t comment on the blockage of substance P, but I will say that this site doesn’t know what it’s talking about when it comes to tendons. First, tendons aren’t joints; the structures are completely different (collagen vs. cartilage). So the fact that something that works in a joint has absolutely no bearing on tendons, and talking about “joints affected by tendonitis” is simply wrong. Second, the study is about arthritis pain, not tendon pain. Sorry, but those are different, too.

So, one argument down. Another is that applying heat to a painful area can produce relief. There may be some merit to this idea. After all, people use hot-packs all the time. But the problem (as I mentioned in my post about menthol and tendon pain) is that capsaicin doesn’t produce any real heat. Sure, you’ll feel like something’s on fire, but no actual increase in temperature occurs. The capsaicin just causes your body’s heat sensors to react as though there was real heat.

To put it bluntly, using capsaicin for tendon pain is a bad idea. Icing a tendon can be a good modality for tendon pain that’s not too severe and hasn’t been around for long, but even that won’t be effective for persistent tendon pain. Heat…well, heat just isn’t on the scientifically-verified menu — not even real heat. Finally, there is absolutely no research showing that topical capsaicin creams and so on are effective, and anecdotal reports of trying to rub chili powder and so on directly onto the skin usually end badly.

If you have persistent, long-term tendon pain, it’s a good bet that you don’t have tendonitis, but tendonosis (take my free, one-minute test to find out which you have), and neither heating nor cooling is going to help much. Long-term pain usually means tendon degeneration, and for that you’re going to need some targeted exercises and a good nutritional strategy to rebuild the affected area. Target Tendonitis provides both, and comes with a 60-day money-back guarantee.

Menthol and Tendon Pain

Let’s talk about menthol.

Menthol is a naturally occurring compound that comes from mint plants. It produces a cooling effect by stimulating the cold receptors that people have on their skin, sort of a mirror image of how capsaicin stimulates the heat receptors. Capsaicin doesn’t actually raise the temperature of anything, but if you have a mouthful of hot peppers it sure can feel like it. In the same way, menthol doesn’t actually lower the temperature, it just makes your skin feel like it’s gotten cold.

What does this have to do with tendon pain? Well, there are a lot of tendonitis “treatment” products out there, generally sprays or creams, that contain menthol. These products often claim to provide “instant relief” from tendon pain with just a quick application of the product, and usually have lots of great testimonials from people who say that it’s the best thing since sliced bread. Admittedly, it does feel a little like putting ice on your problem area. There is a cooling sensation, which is pleasant, and after a while the area will become somewhat numb. So you feel better – at least for a while. (The critical difference here is that ice, by actually producing a lower temperature, has a beneficial effect on inflammation, whereas menthol has no such effect.)

But these sprays and creams can actually do more harm than good. For one thing, menthol has never been shown to have any real effect on the structure of tendons themselves. In other words, there is no healing action. None. If you get “relief” from the pain but still have the underlying problem, it becomes that much easier to ignore your body’s warning signs (which is what pain really is) and do something that’s really going to injure you. If that happens, you can easily go from having a painful – but healable – tendon to a ruptured tendon. And if that happens the only option is surgery.

Also, since you’re not actually treating the condition, you have to keep buying the spray or cream in order to continue to experience relief. I don’t know about you, but I much prefer to actually fix the problem so I don’t become a financial slave to some company that’s putting out a “feel good” spray.

Menthol can be great for providing temporary relief for temporary conditions like sunburn, and of course it makes chewing gum, toothpaste and so on taste better. But if you’re looking for tendon pain therapy, any product that has menthol in it should be avoided. Every one that I’ve seen so far has been a scam.

Blackberry Thumb, iPhone Thumb…

I ran across an interesting (and slightly horrifying) article in the Calgary Herald a couple of days ago (text and link are below). People usually think of tendon pain as something that happens in the larger joints, the elbows, knees, ankles and so on. But it can happen anywhere that there is a repetitive stress and pattern overload. Here’s an extreme case:

Banker undergoes ‘BlackBerry thumb’ surgery because she used her iPhone too much

By Katya Wachtel, Business Insider August 29, 2010

A mortgage banker just had to have surgery on her thumb because she was using her iPhone too much, according to WTSP.

The hospital says her condition is best known as “Blackberry thumb.” However, since she was using an iPhone, “iPhone thumb” is obviously more appropriate in her case.

Symptoms of Blackberry thumb include pain, inflammation, numbness and tingling.

The Philly woman might have realized she felt some of the symptoms had she not spent up to 12 hours a day in communication with clients on her iPhone.

The tendons in her thumb became so severely inflamed, they required removal.

Her need for surgery would (almost?) be funny, but apparently surgery on the hand is very serious and it’s going to be a long time before she can use her phone again. Recovery time for tendon surgery can be up to two months or longer.

“Most hand tendon injuries take longer to recover than most other operations elsewhere in the body,” according to the American Society for Surgery of the Hand

Read more:…#ixzz0y2Lt9Vag

I have complete confidence that the techniques I explain in my book will cure most people, but in this case I wouldn’t be completely positive. I’m fairly sure that with the amount of stress this lady placed on her tendons she’s gone beyond tendonitis (simple inflammation) and well into tendonosis (actual damage to the tendon itself). But if you’ve got tingling and numbness you’re probably experiencing some nerve damage along with the tendon problem, and that’s frankly beyond my expertise. Still, I think that if it were me I’d invest thirty bucks–especially since there’s a money-back guarantee–and see what happened before I opted for surgery.

For those who are experiencing some pain (but not as severe as the lady in the article), there is a quick and accurate tendon test on this page that will tell you what sort of pain you have, and what you can do about it.

Writer’s Tendonitis

Nadia Lee, an up and coming writer of romance fiction, interviewed me a few days ago for her blog. She’d been suffering from wrist and forearm pain (mainly minor RSIs stemming from too much typing and mousing) for a few weeks and — after seeing a doctor and getting physical therapy for months — finally got sick of it. Since I know her in real life I gave her some advice on how to get rid of her pain, as well as tips on how to manage the cause of the problem in the future.

While I don’t give away any secrets in the interview, if you’re a writer it might be worth your while to check it out.